TREANDA for CLL could be a winner

Implications: The ease of use compared to fludarabine regimens, and the superior efficacy vs chlorambucil, puts TREANDA in the sweet spot for potential front-line use in CLL.

Analysis: CLL is the most common adult leukemia. Fludarabine-bsed regimens have the highest complete remission rates, but have been rather difficult regimens to administer, with high rates of infectious complications. TREANDA provides an alternative, which is still IV and thus financially-viable for small offices to administer. It's 20+ year track record is another advantage, compared to newer agents like Revlimid which work through unknown mechanisms. (Also, Revlimid was recently found to be too toxic for CLL in a trial subsequent to the one that got a lot of press after ASH 2007).

Compared to fludarabine, Treanda will clearly be my preferred front-line agent, especially for the most common type of CLL patient: someone older, with usually less aggressive disease. These patients do not do well with fludarabine, and finally we have another alternative besides the very weak treatment of chlorambucil.

While the focus on Treanda seems to be getting the NHL approval, I think its approval for CLL is very exciting.